Provider Demographics
NPI:1700522968
Name:VAUGHAN, ADRIANA COGLIANDRO
Entity Type:Individual
Prefix:
First Name:ADRIANA
Middle Name:COGLIANDRO
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 HURD AVE
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906-2514
Mailing Address - Country:US
Mailing Address - Phone:178-135-3881
Mailing Address - Fax:
Practice Address - Street 1:36 HURD AVE
Practice Address - Street 2:
Practice Address - City:SAUGUS
Practice Address - State:MA
Practice Address - Zip Code:01906-2514
Practice Address - Country:US
Practice Address - Phone:178-135-3881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS32943381106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician